Barw Barw Medical Journal 2960-1959 2025 12 12 Early Onset of Coronary Subclavian Steal Syndrome: A Case Report and Literature Review 52 56 10.58742/bmj.v4i1.217 eng Jalal Gareeb Department of Cardiology, Sulaymaniyah Teaching Hospital, Interventional Cardiology Center, Sulaymaniyah, Iraq. Jalal.Gareeb@gmail.com Farman J. Ahmed Department of Cardiology, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. farman.faraj@gmail.com Hemn H. Mohammad Department of Cardiology, Sulaymaniyah Teaching Hospital, Interventional Cardiology Center, Sulaymaniyah, Iraq. hemn.mohammed@gmail.com Karokh F. Hamahussein Department of Gastroenterology and Hepatology, Gastroenterology and Hepatology Teaching Hospital, Zanko Street, Sulaymaniyah, Iraq. karokh.hussein@gmail.com Soran H. Tahir College of Medicine, Department of Clinical Sciences, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. soran.tahir@univsul.edu.iq Sumaya Sabah Abdulrahman Department of Scientific Affairs, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. sumaya.abdulrahman@gmail.com Meer M. Abdulkarim Department of Scientific Affairs, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. meermohammedabdulkarim@gmail.com Suhaib H. Kakamad Department of Immunology and Hematology, College of Medicine, Kurdistan University of Medical Science, Sanandaj, Iran. suhaib.kakamad@gmail.com 2025 09 22 Introduction Coronary subclavian steal syndrome (CSSS) is a rare phenomenon that often goes undiagnosed and causes severe complications, including death. This report presents a case of CSSS with unexpectedly early presentation following coronary artery bypass grafting (CABG). Case presentation A 49-year-old male with diabetes, smoking history, and ischemic heart disease underwent CABG with a left internal mammary artery graft to the LAD and saphenous vein grafts. Three months later, he presented with exertional chest pain and left arm discomfort. Examination revealed a significant inter-arm blood pressure difference (right 140/90 mmHg, left 90/65 mmHg) and a diminished left radial pulse. Computed tomography angiography revealed complete proximal left subclavian artery occlusion with patent grafts. Percutaneous revascularization with balloon pre-dilatation and a 7.0 × 27 mm stent restored flow. The procedure was uneventful, and at 10-month follow-up, he remained asymptomatic with normalized arm pressures. Literature review A review of ten recent CSSS cases revealed a predominance of males (7/10), with ages ranging from 58 to 81 years. Comorbidities included cardiovascular, renal, and metabolic disorders. Chest pain was the most frequent presenting symptom. The interval from CABG to CSSS onset ranged from two days to 13 years. Management strategies encompassed percutaneous coronary interventions, nitrates, antihypertensives, and statins, with all patients achieving favorable outcomes. Conclusion Coronary subclavian steal syndrome can present shortly after CABG. Percutaneous endovascular stenting via a dual approach might offer good long-term outcomes.